Case report: Retrograde endovascular recanalization of vertebral artery occlusion with non-tapered stump via the deep cervical collateral

Frontiers in Neurology

Neurology

Bin Mei¹  Junjian Zhang¹  Han Qiu¹  Zhiming Kang¹  Dong Sun¹ 

[1] Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China;Hubei Province Clinical Research Center for Dementia and Cognitive Impairment, Wuhan, Hubei, China;

关键词: vertebral artery occlusion;    non-tapered stump;    ischemic stroke;    endovascular recanalization;    retrograde;    deep cervical collateral;   

DOI  :  10.3389/fneur.2023.1246151

 received in 2023-06-24, accepted in 2023-08-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionVertebral artery (VA) occlusive disease is the major cause of posterior circulation ischemic stroke. Endovascular recanalization has been reported as a feasible treatment for patients with symptomatic VA occlusion refractory to optimal medical therapy. However, VA occlusion with non-tapered stump exhibits a low technique success rate when treated by antegrade endovascular therapy because of increased difficulty in passing the guidewire into the occluded segment. Herein, we presented a novel endovascular approach to recanalize chronically occluded VA with a non-tapered stump using a retrograde method via the deep cervical collateral, which has not been reported before.Case presentationThe present case was a patient with VA ostial occlusion with non-tapered stump and distal severe stenosis of the left VA who had recurrent posterior circulation transit ischemic attacks under optimal medical therapy. CT angiography demonstrated proximal non-tapered occlusion and distal severe stenosis of the left VA, and that the right VA did not converge with the left VA into basilar artery. Endovascular treatment was recommended and performed on this patient. However, antegrade endovascular recanalization of the left VA origin occlusion failed because the micro guidewire was unable to traverse the occluded segment. Fortunately, robust collateral from the deep cervical artery to the V3 segment of the left VA developed, in which we advanced the micro guidewire to the V3 segment of the left VA and reversely passed the micro guidewire through the occluded segment. Then, the occlusion and stenosis of the left VA were successfully resolved with angioplasty and stenting. After the procedure, the patient reported no neurological symptoms under medical therapy during 3-month follow-up.ConclusionAntegrade endovascular recanalization of VA occlusion with a non-tapered stump is a challenge. The retrograde endovascular method via the cervical collateral may be an alternative for this type of VA occlusion, which requires further exploration.

【 授权许可】

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Copyright © 2023 Qiu, Kang, Sun, Mei and Zhang.